Provider Demographics
NPI:1558595124
Name:SEO, IN SOOK (IN SOOK SEO, MD)
Entity Type:Individual
Prefix:DR
First Name:IN SOOK
Middle Name:
Last Name:SEO
Suffix:
Gender:F
Credentials:IN SOOK SEO, MD
Other - Prefix:
Other - First Name:IN SOOK
Other - Middle Name:
Other - Last Name:SEO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:IN SOOK SEO, MD
Mailing Address - Street 1:1555 E 79TH ST
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46240-2702
Mailing Address - Country:US
Mailing Address - Phone:317-257-3562
Mailing Address - Fax:
Practice Address - Street 1:1555 E 79TH ST
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46240-2702
Practice Address - Country:US
Practice Address - Phone:317-257-3562
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-11
Last Update Date:2009-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN0102611A291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory